Autoimmune Bullous Diseases and Drugs

  • Margaret A. Stafford
  • Shivani S. Patel
  • Lindsay N. Boyers
  • Chante Karimkhani


Drug-induced bullous disorders encompass a diverse array of clinical presentations determined by the pathology at the dermal/epidermal junction. These include bullous pemphigoid, dermatitis herpetiformis, linear IgA, and pemphigus variants. Fluid-filled blisters encompass all drug-induced bullous disorders after a latency period; however, other clinical features including mucosal involvement can vary.

In linear IgA bullous dermatosis, vancomycin is the most common offending agent. Pemphigus variants, including vulgaris and foliaceus, often present after the use of thiol, phenol, and non-thiol containing drugs. More than 50 different drugs have been associated with the onset of bullous pemphigoid, with thiols being a major group tied to drug-induced bullous pemphigoid. A few cases of drug-induced dermatitis herpetiformis have been reported in the literature. Most of these cases involve hormone-modulating or immunomodulating drugs.

Overall, drug-induced bullous dermatoses respond rapidly to cessation of the offending agent and corticosteroid therapy. It is therefore important to always have clinical suspicion for the drug-induced form of autoimmune bullous dermatoses.


Bullous pemphigoid Dermatitis herpetiformis Drug eruption Drug-induced Linear IgA Linear IgA bullous dermatosis Pemphigus Pemphigus foliaceus Pemphigus vulgaris 

Suggested Reading

Drug-Induced Bullous Pemphigoid

  1. Habif TP, editor. Clinical dermatology. 5th ed. Philadelphia: Mosby Elsevier; 2010.Google Scholar
  2. Lee JJ, Downham 2nd TF. Furosemide-induced bullous pemphigoid: case report and review of literature. J Drugs Dermatol. 2006;5(6):562–4.PubMedGoogle Scholar
  3. Lo Schiavo A, Ruocco E, Brancaccio G, Caccavale S, Ruocco V, Wolf R. Bullous pemphigoid: etiology, pathogenesis, and inducing factors: facts and controversies. Clin Dermatol. 2013;31(4):391–9.CrossRefPubMedGoogle Scholar
  4. Stavropoulos PG, Soura E, Antoniou C. Drug-induced pemphigoid: a review of the literature. J Eur Acad Dermatol Venereol. 2014;28:1133–40. doi: 10.1111/jdv.12366.CrossRefPubMedGoogle Scholar
  5. Sticherling M, Erfurt-Berge C. Autoimmune blistering diseases of the skin. Autoimmun Rev. 2012;11(3):226–30.CrossRefPubMedGoogle Scholar
  6. Vassileva S. Drug-induced pemphigoid: bullous and cicatricial. J Drugs Dermatol. 2006;5(6):562–4.Google Scholar
  7. Wolff K, Johnson R, Saavedra AP, editors. Fitzpatrick’s color atlas and synopsis of clinical dermatology. 7th ed. New York: The McGraw-Hill Companies, Inc; 2012.Google Scholar

Drug-Induced Pemphigus

  1. Anadolu RY, Birol A, Bostanci S, Boyvat A. A case of pemphigus vulgaris possibly triggered by quinolones. J Eur Acad Dermatol Venereol. 2002;16(2):152–3.CrossRefPubMedGoogle Scholar
  2. Baroni A, Russo T, Faccenda F, Piccolo V. Amoxicillin/clavulanic-acid-induced pemphigus vulgaris: case report. Acta Dermatovenerol Croat. 2012;20(2):108–11.PubMedGoogle Scholar
  3. Bauza A, Del Pozo JL, Saus C, Martin A. Pemphigus-like lesions induced by imiquimod. Clin Exp Dermatol. 2009;34(5):60–2.CrossRefGoogle Scholar
  4. Brenner S, Goldberg I. Drug-induced pemphigus. J Clin Dermatol. 2011;29:455–7.CrossRefGoogle Scholar
  5. Brenner S, Bialy-Golan A, Anhalt G. Recognition of pemphigus antigens in drug-induced pemphigus vulgaris and pemphigus foliaceus. J Am Acad Dermatol. 1997;36:919–23.CrossRefPubMedGoogle Scholar
  6. Maruani A, Machet MC, Carlotti A, Giraudeau B, Vaillant L, Machet L. Immunostaining with antibodies to desmoglein provides the diagnosis of drug-induced pemphigus and allows prediction of outcome. Am J Clin Pathol. 2008;130:369–74.CrossRefPubMedGoogle Scholar
  7. Venugopal SS, Murrell DF. Diagnosis and clinical features of pemphigus vulgaris. Immunol Allergy Clin North Am. 2012;32(2):233–43.CrossRefPubMedGoogle Scholar
  8. Yoshimura K, Ishii N, Hamada T, Abe T, Ono F, Hashikawa K, et al. Clinical and immunological profiles in 17 Japanese patients with drug-induced pemphigus studied at Kurume University. Br J Dermatol. 2014;171(3):544–53.CrossRefPubMedGoogle Scholar

Drug-Induced Linear IgA Bullous Dermatosis

  1. Aultbrinker EA, Starr MB, Donnenfeld ED. Linear IgA disease. The ocular manifestations. Ophthalmology. 1988;95(3):340–3.CrossRefPubMedGoogle Scholar
  2. Chan LS, Regezi JA, Cooper KD. Oral manifestations of linear IgA disease. J Am Acad Dermatol. 1990;22:362–5.CrossRefPubMedGoogle Scholar
  3. Chanal J, Ingen-Housz-Oro S, Ortonne N, Duong TA, Thomas M, Valeyrie-Allanore L, et al. Linear IgA bullous dermatosis: comparison between the drug-induced and spontaneous forms. Br J Dermatol. 2013;169(5):1041–8.CrossRefPubMedGoogle Scholar
  4. Fortuna G, Salas-Alanis JC, Guidetti E, Marinkovich MP. A critical reappraisal of the current data on drug-induced linear immunoglobulin a bullous dermatosis: a real and separate nosological entity? J Am Acad Dermatol. 2012;66(6):988–94.CrossRefPubMedGoogle Scholar
  5. Pastuszczak M, Lipko-Godlewska S, Jaworek AK, Wojas-Pelc A. Drug-induced linear IgA bullous dermatosis after discontinuation of cefuroxime axetil treatment. J Dermatol Case Rep. 2012;6(4):117–9.PubMedCentralCrossRefPubMedGoogle Scholar
  6. Zone JJ, Taylor TB, Meyer LJ, Petersen MJ. The 97 kDa linear IgA bullous disease antigen is identical to a portion of the extracellular domain of the 180 kDa bullous pemphigoid antigen, BPAg2. J Invest Dermatol. 1998;110(3):207–10.CrossRefPubMedGoogle Scholar

Drug-Induced Dermatitis Herpetiformis

  1. Grimwood RE, Guevara A. Leuprolide acetate-induced dermatitis herpetiformis. Cutis. 2005;75(1):49–52.PubMedGoogle Scholar
  2. Marakli SS, Uzun S, Ozbek S, Tuncer I. Dermatitis herpetiformis in a patient receiving infliximab for ankylosing spondylitis. Eur J Dermatol. 2008;18(1):88–9.PubMedGoogle Scholar
  3. Yu SS, Connolly MK, Berger TG, McCalmont TH. Dermatitis herpetiformis associated with administration of a gonadotropin-releasing hormone analog. J Am Acad Dermatol. 2006;54(2 Suppl):S58–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Margaret A. Stafford
    • 1
  • Shivani S. Patel
    • 1
  • Lindsay N. Boyers
    • 2
  • Chante Karimkhani
    • 3
  1. 1.College of MedicineMedical University of South CarolinaCharlestonUSA
  2. 2.School of MedicineGeorgetown UniversityWashington, DCUSA
  3. 3.College of Physicians and SurgeonsColumbia UniversityNew YorkUSA

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